Revue médicale suisse
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Revue médicale suisse · Dec 2010
[Non invasive ventilation in the ICU for the neuromuscular patient: legal issues].
The legal frame in which chronic mechanical ventilation is placed in Switzerland and France is discussed in this article. Safety of the patients and responsibility of caregivers are considered. We also discuss the ethical and legal aspects of the end-of-life of these patients, particularly when they decide that mechanical ventilation must be interrupted because they do not more tolerate their poor quality of life, and when they deliberately decide to die.
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The process of health care delivery in Intensive Care Units (ICUs) is subject to significant workload fluctuations and unpredictable events. Medical and nursing staff, while relying on protocols, must adjust to these "out of the routine" disturbances by displaying initiative and innovation. ⋯ The assumption is that this resilience ability may be intentionally built by a specific work organization. The theoretical framework of "resilience engineering" described here could be a powerful tool in organizational designing suited to the ICUs.
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The Faculty of Biology and Medicine of Lausanne has integrated education of family medicine all along its new undergraduate medical curriculum. The Institute of general medicine is in charge to implement those offers among which two are presented hereafter. ⋯ A mandatory one-month internship in the medical practice offers an experiential immersion into family medicine for all students. In a meeting at the end of their internship, students discuss in group with their peers their individual experiences and are asked to identify, based on their personal experience, the general concepts of the specialty of family medicine and general practice.